RISK FACTORS FOR ESOPHAGOGASTRIC ANASTOMOSIS FAILURE DEPENDING ON TYPE OF ESOPHAGEAL PLASTY

Abstract

Aim. The aim of the study was to improve the results of treatment of esophageal anastomosis failure in esophagoplasty. Materials and methods. During 20 years, 262 esophageal resections with different variants of plasty for cancer and benign esophageal diseases were fulfilled. Anastomosis failure was developing in 65 % of cases (24,8 %). Results. More frequently anastomosis failure was developing after the posteromediastinal esophagogastroplasty - in 43 patients (38,4 %). Following the proximal gastric resections with esophageal resection from laparotomy approach, complications were diagnosed 11 patients (24,3 %), gastrectomy with esophageal resection - in 6 persons (16,2 %). Anastomosis failure occurred after Lewis surgeries - in 5 cases (7,7 %). Twenty three (35,4 %) patients underwent the repeated surgeries. Thirty one patients died (11,4 %). Death caused by purulent complications following anastomosis failure was registered in 58,1 % of patients. Surgical circular stapling instruments CDH and CEEA used for the formation of anastomosis permitted to reduce its failure rate from 34,1 to 15,4 %, and experience of esophageal surgery - to decrease lethality from 19,1 to 6,8 % for 20 years. Conclusions. Esophageal anastomosis failure more often occurs after the posteromediastinal esophagogastroplasty, rarely - after Lewis surgery that is connected with peculiar features of transplant blood supply. Machine suture raises reliability of anastomosis.